OE4

Now that we're past Thanksgiving weekend and the big December 15th deadline (for January coverage) is coming up fast, OE4 enrollments should have started ramping up significantly, on the order of 250,000 per day or more nationally (around 190K via HC.gov).

As noted last week, so far, total enrollments have been pacing my overall projections almost perfectly...slightly ahead of my estimates for the first month, in fact. Assuming this continues, national QHP selections should have broken 4.1 million nationally sometime Monday night (12/05), with around 3.1 million of those coming via the federal exchange.

The Connecticut ACA exchange, AccessHealthCT, issued a press release today reminding Connecticut residents in general of the December 15th deadline for January 1st coverage. They also stressed, however, that while most current enrollees will be automatically renewed into either their existing policy, there are about 26,000 current enrollees who can't be auto-renewed because their carrier is leaving the exchange in 2017:

On December 1st, AHCT’s automatic renewal process began. The AHCT eligibility system will automatically enroll into 2017 coverage customers who have selected auto-renew and whose plans are still available. “But, there are 26,000 people who currently have coverage through AHCT who cannot auto-renew and must take action to renew their 2017 plans,” Wadleigh noted. Wadleigh reminds all customers “they should shop around and compare your options for 2017– that’s the purpose of the marketplace.”

Connect for Health Colorado just posted an official enrollment update:

DENVER — More than 37,000 Coloradans selected healthcare coverage for 2017 through the state health insurance Marketplace in November, a rate 23 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®.

“The pace of sign-ups during the first month of this Open Enrollment has been very heartening,” said Connect for Health Colorado CEO Kevin Patterson. “We know that there is a lot of discussion now about the future direction of healthcare, but what remains constant and true is the importance of protecting the health and financial future of all Coloradans. I encourage everyone who needs health insurance to check to see if they qualify for financial assistance, review the available plans, and complete an enrollment before the last-minute rush.”

In the first month of the annual Open Enrollment period, Coloradans selected 37,948 medical and dental insurance plans. That compares to 30,777 such plan selections in November 2015.

Last week I decided to once again take a crack at projecting not only the final number of 2017 Open Enrollment Period QHP enrollments nationally, but on a state-by-state basis. I started with a simple assumption of "2016 + 8.7%" (to match the national 13.8 milliion vs. 12.7 million projection made by both myself and the HHS Dept.), and then adjusted each state higher or lower based on various factors.

Now that CMS has broken out the first 4 weeks' worth of QHP selections via the federal exchange, in addition to the partial data I have on hand for some of the state-based exchanges, it's time to see where things stand compared to my personal projections. The only states where I know of an official projection are California and Connecticut, and even these have some wiggle room as they're more ranges than exact numbers.

With that in mind, here's what it looks like at the moment. Click the graph below for a high-resolution version. Things to note:

Minnesota's "first-come-first-serve" enrollment cap system caused a massive surge in early QHP selections...so much so that they kicked things off by signing people up at a pace twelve times faster than last year in the first few days.

That pace has slowed down considerably since then, but they're still well ahead of last year. In the first 17 days of OE3, MNsure was enrolling 404 people per day. In the first 27 days of OE4, MNsure has enrolled 29,783 people...or 1,103 per day:

With more than four weeks of open enrollment in the books, more than 57 percent of Minnesotans enrolling in a private health insurance plan through MNsure are qualifying for financial help available only through the state-based health insurance marketplace. The average tax credit amount going to MNsure customers will be more than three times higher in 2017 than it was in 2016.

Last week I estimated that the Colorado exchange had around 26.4K QHP selections in the first 22 days of OE4 based on some fuzzy extrapolation.

Today, the Connect for Health Colorado Finance & Operations Committee had a meeting with the following slideshow...showing that they're doing even better than that: 29,045 QHP selections in those same 22 days.

However, there's also another important tidbit here (last slide below): While the average unsubsidized premium rates for Colorado exchange enrollees officially went up 16.9%, the final premium cost to the enrollees is actually dropping by 1.9% (from $214/month to $210/month):

In Colorado, the typical consumer who has already used Affordable Care Act subsidies to buy exchange plan coverage for 2017 is on track to spend less on premiums next year.

As I've noted before, Connecticut has an unusual policy for reporting 2017 QHP selections. Instead of reporting the number of renewing enrollees + new additions, they start out by assuming every current enrollee will be renewed for the upcoming year, add the new additions and the subtract those who actively choose not to renew their policy. Technically, this makes it look like Connecticut has already broken 100,000 enrollees for 2017--over 80% of their enrollment target number--even though we're only 4 weeks into the enrollment period. As a result, I can't really give an accurate "enrolled for 2017" number until the third week of December, when every state has officially entered their autorenewed enrollees into the system. 

Having said that, they are reporting the number of new enrollees signing up on a fairly regular basis:

Last year I took a shot at predicting not only total Open Enrollment QHP selections nationally, but also on a state-by-state basis. Seeing how I ended up overestimating by a whopping 2 million people nationally (projection: 14.7 million; actual: 12.7 million...about a 16% difference), it shouldn't be surprising that I was also way off on most of the individual states.

Of the 50 states +DC, I was within +/- 5% in only 13 states. 6 states overperformed my projections by more than 5 points (MA, UT, MD, SD, MN and TN)...but 32 states underperformed by more than 5 points, and 17 states came in more than 15% lower than I was expecting. Ouch.

I was therefore understandably hesitant to put my neck out there again this year...and after the unexpected results of the Presidential election, all bets seemed to be off. However, seeing how the first couple of weeks of OE4 seem to be holding pretty closely to my national projections so far, I've decided to go ahead and post my state-level calls after all.

When I last checked in on Colorado, they were reporting 2017 enrollments at a rate 30% faster than last year (16,305 in 13 days vs. 12,496 in the first 13 days last year).

Today they didn't issue an official update, but did give enough to piece together an estimate via an email to their enrollees:

Dear Connect for Health Colorado Stakeholders, 

As we approach the Thanksgiving holiday, we’re busy as ever enrolling customers. In fact, enrollments are outpacing our numbers by more than 25 percent over this time last year, with our biggest day falling the day after the election. And, this is a trend we’re seeing nationally. 

While the recent election has raised a lot of questions about the future of healthcare, what remains constant and true is the importance of protecting the health and financial future of our customers. Broken bones, disease and other chronic conditions aren’t political, but can happen at any time and in some cases, are preventable with access to care and health insurance. Our dedication to helping customers remains as strong as ever. 

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